Practica Oto-Rhino-Laryngologica

Disinfection and Sterilization in the Otolaryngologic Outpatient Clinic

Kohichiro Shigeno

2004 Volume 97 Issue 8 Pages 667-672
Published: August 01, 2004
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.97.667

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For the disinfection and sterilization of otolaryngologic instruments in outpatient clinics, two processes exist. One process is used for heat-resistant instruments: cleaning→physical disinfection→drying→ (autoclave sterilization), while the other process is used for non heat-resistant instruments: cleaning→chemical disinfection→rinsing→drying. In both processes, cleaning is especially important. For metallic instruments, disinfection by boiling or hot water disinfection combined with autoclaving for sterilization provides safe and economical disinfection. Instruments such as the nebulizer can be soaked in sodium hypochlorite, dried, then used. Especially important in the case of the nebulizer is clean management of the inhalant liquid. In disinfection of the flexible endoscope, the use of an automated cleaning machine has spread. Using Ortho-phthalaldehyde, disinfection with a short immersion time (five minutes) is possible. Finally, to prevent nosocomial infection, it is critical that all medical staff wash their hands properly.

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AIDS Associated Malignant Lymphoma

A. Inoue, [in Japanese], [in Japanese]

2004 Volume 97 Issue 8 Pages 674-675
Published: August 01, 2004
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.97.674

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A Case of Epidermal Nevus Syndrome with Bilateral Sensorineural Hearing Loss

Naotaka Aizawa, Toshiyuki Fujisaki, Kouki Noto, Sugata Takahashi

2004 Volume 97 Issue 8 Pages 677-679
Published: August 01, 2004
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.97.677

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We report the first known case of epidermal nevus syndrome with bilateral sensorineural hearing loss. A 5-year-old boy with nevus extending from the right side of the neck to the thigh was brought to our department because of apparent speech delay since 3 years of age. Pure tone audiometry demonstrated bilateral moderate hearing loss, although development other than hearing and speech was within normal limits. CT scan did not show any evidence of abnormality in the intracranium or temporal bone. After providing hearing aids, language development was improved. Epidermal nevus syndrome is defined as one of neurocutaneous syndrome, and we should consider possible complication of hearing in neonates with extensive nevus.

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Two Cases of Effective Cochlear Implantations for Deafness Following Mumps

Shu Kikuta, Kozo Kumakawa, Eikichi Tokunaga, Masaaki Yamane

2004 Volume 97 Issue 8 Pages 681-684
Published: August 01, 2004
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.97.681

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While it is well known that mumps is a potential cause of deafness, it is not generally appreciated that it can produce total deafness. The damage is usually unilateral but bilateral disorder has been recorded. Deafness following mumps is usually severe and generally permanent. Only a mumps vaccination prevents deafness. Two cases are presented with severe bilateral hearing loss following mumps in spite of intensive conventional therapies. A 5 year-old female without natural infections of mumps or mumps vaccination already had bilateral deafness on hospitalization. She had no vestibular symptoms. After 5 months, she had cochlear implantation therapy. A 26 year-old woman without natural infections of mumps or mumps vaccination had bilateral progressive deafness in 2 weeks and temporary vestibular symptoms. After 6 months, she also had cochlear implantation therapy. The hearing ability of both cases after operation was very satisfactory owing to no complications (otitis media or malformation), enough inserting channels and comprehensive rehabilitations. We emphasize the importance of mumps vaccination and recommend a cochlear implant therapy for bilateral total deafness following mumps.

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A Case Report of Localized Wegener's Granulomatosis Presenting as Otitis Media

Reiko Kobayashi, Suetaka Nishiike, Rumi Kanbara, Hitoshi Ogino, Takesh ...

2004 Volume 97 Issue 8 Pages 685-690
Published: August 01, 2004
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.97.685

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Wegener's granulomatosis is a distinct clinicopathologic entity characterized by granulomatosis vasculitis of the respiratory tract accompanied by glomerulonephritis. We report a case of a 56-year-old female with localized Wegener's granulomatosis presenting as otitis media. The patient complained of right ear pain. Antibiotic treatment was ineffectual and right sensorineural deafness and right facial palsy became apparent. Perinuclear anti-neutrophil cytoplasmic antibody (p-ANCA) was positive, but cytoplasmic anti-neutrophil cytoplasmic antibody (c-ANCA) was negative. The histopathologic appearance of granulation tissue in her tympanic and nasal cavity indicated inflammatory granulation involving multinucleated giant cells and epithelioid cells. The disease did not involve her lung or kidney, so it was diagnosed as localized Wegener's granulomatosis. Glucocorticoid treatment with cyclophosphamide improved the right hearing loss and facial palsy. CRP and p-ANCA became negative.
Early diagnosis of Wegener's granulomatosis is difficult because of atypical manifestations of the disease, but ANCA measurements may be effective in the diagnosis. The present case suggests that inner ear blood flow impairment due to p-ANCA-associated small vessel vasculitis induces hearing loss.

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Wegener's Granulomatosis of the Ear: Case Report

Mizuho Yagisawa, Junichi Ishitoya, Yasunori Sakuma, Takafumi Yoshida, ...

2004 Volume 97 Issue 8 Pages 691-695
Published: August 01, 2004
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.97.691

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Wegener's granulomatosis is a rare autoimmune disease affecting predominantly the nose or paranasal sinuses. Other organs of the upper air way may, however, be involved either alone or as parts of generalized disease. Occasionally the otological manifestation is the first and only sign of Wegener's granulomatosis.
In this case report we describe Wegener's granulomatosis in a 43-year-old female who complained of right aural discharge. Treatment for otitis media with systemic antibiotics was not effective, and due to persistent headache accompanied by mixed hearing loss, mastoidectomy was performed two months after the initial presentation. Histological examinations revealed granulomatous tissue in the mastoid, showing non-specific granulomatous inflammation. After operation, she developed painful gingival swelling and nasal obstruction. Finally, the patient was diagnosed with Wegener's granulomatosis based on the clinical, histological, and laboratory findings.
Since it is often difficult to confirm the diagnosis histologically, especially in limited types of Wegener's granulomatosis, we consider it better to rely on a test for C-ANCA when positive histological findings are not observed in the biopsy specimens.
The diagnosis should be considered in patients with otitis media that are unresponsive to conventional treatment.

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New Method for Effective Instillation of Nasal Drops in Patients with Olfactory Dysfunction

Junji Miyazaki, Hidetomo Matsushita, Shoichiro Yamada, Akira Inokuchi

2004 Volume 97 Issue 8 Pages 697-705
Published: August 01, 2004
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.97.697

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In order to obtain a sufficient effect when instilling steroid nasal drops in patients with olfactory dysfunction, the medication must reach and be deposited into the olfactory cleft. Some head positions, such as head-down-and-backwards position, are recommended to instill drops. These positions are, however, known to be uncomfortable and can lead to poor patient compliance. Moreover, there is no clear evidence showing that nasal drops can be delivered into the olfactory cleft in these positions.
In this study, we reviewed these positions by utilizing a cadaver head and performing a gravitational flow study using colored nasal drops. The results showed that when using these positions, instilled nasal drops did not reach the olfactory cleft except in limited trials. With the above-mentioned negative points in mind, we devised a new head position, on the side, head down, and found it to be both effective and comfortable for delivering nasal drops into the olfactory cleft.

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A Case of MALT Lymphoma in the Subcutaneous Region of the Cheek

Koji Kudo, Tatsuya Fujiyoshi, Akiko Sakabe, Hideaki Suzuki, Takeyuki F ...

2004 Volume 97 Issue 8 Pages 707-711
Published: August 01, 2004
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.97.707

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MALT lymphoma is characterized as a type of low-grade extranodal B cell lymphoma arising from mucosa-associated lymphoid tissue (MALT). It is thought to be associated with autoimmune diseases, e. g., Sjögren's syndrome and Hashimoto's disease, or inflammatory diseases, e. g., Helicobacter pylori infection of the stomach. We report a rare case of MALT lymphoma of the cheek. A 76-year-old woman was referred to our clinic, complaining of swelling of the left cheek. CT and MRI showed a solid mass with a smooth surface in the subcutaneous region of her left cheek. Total resection of the tumor was performed. The tumor was histopathologically diagnosed as MALT lymphoma. No other lesions were detected in systemic examinations. A complete remission was obtained with 4 courses of Rituximab (anti-CD20 monoclonal antibody) therapy and irradiation at 40Gy. The patient is currently free from disease 21 months after surgery.

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Parotid Tumor Statistics for the Past Five Years

Soichi Yamaguchi, Kohei Sueno, Takeshi Yamaguchi, Yukimi Asano, Kazuta ...

2004 Volume 97 Issue 8 Pages 713-718
Published: August 01, 2004
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.97.713

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We reviewed the case of 40 patients with parotid tumor who underwent an operation in the past five years.
Results: The patients included 23 (57.5%) males and 17 (42.5%) females. The average age was 53.4 years old with a range of 19 to 71 years. Thirty eight (95.0%) had benign tumor, and 2 (5.0%) had malignant tumor. Tc scintigraphy was performed in 37 out of the 40 patients, and 9 patients showed positive results. Six patients had warthin's tumor, and 3 had pleomorphic adenoma. In other words, 66.7% were positive for warthin's tumor. Ga scintigraphy was performed in 31 out of the 40 patients. Nine were positive out of the 10 benign tumor that showed a positive result. None of the cases had permanent facial palsy as a postoperative complication. Transient facial palsy was exhibited by 13 patients (32.5%), but they all improved 2 weeks to 6 months. In addition, we experienced 1 case of salivary fistula.
Discussion: Pleomorphic adenoma was noted in 63.2%, and warthin's tumor in 23.7%. There was no gender difference for pleomorphic adenoma, but 8 out of the 9 patients with warthin's tumor were men. The average age was 47.0 for pleomorphic adenoma and 58.7 for warthin's tumor which was in accordance with conventional reports. The Tc scintigraphy positive rate of warthin's tumor was low, 66.7%, in comparison with that in conventional reports. In addition, 90% of the tumors that showed positive results in Ga scintigraphy were preoperatively positive tumors, indicating the diagnostic usefulness of this. Transient facial palsy was a complication in 32.5% of the patients, which was similar to the rate in the conventional report. We experienced 1 case salivary fistula, which did not improve with conservative treatment. We opened the wounded area, and drained it by pressing.

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Partial Glossectomy for Early Tongue Cancer

Yo Kishimoto, Shinji Suzuki, Yasutaka Kawata, Shinichi Takagita, Kazuh ...

2004 Volume 97 Issue 8 Pages 719-723
Published: August 01, 2004
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.97.719

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We performed partial glossectomies in 21 patients with tongue cancer at Tenri Hospital from 1990 to 2001.
Three patients suffered recurrence: one had local recurrence with regional node recurrence and the others developed recurrence only in the regional lymph nodes. One of them refused all medical treatments and died, and the other patients survived with salvage treatments.
As a medical treatment for early tongue cancer, we consider that elective neck dissection and post-operative radiotherapy are not always necessary and that sometimes partial glossectomy is sufficient.

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Intramuscular Metastasis from Oropharyngeal Cancer

Koji Nishimura, Ken Ishijima, Hiroaki Sato

2004 Volume 97 Issue 8 Pages 725-729
Published: August 01, 2004
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.97.725

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Skeletal muscle is an uncommon site of metastasis in the field of head and neck cancer. We report here a rare case of oropharyngeal squamous cell carcinoma with right bicep intramuscular metastasis. Our patient had advanced oropharyngeal carcinoma and complained of right upper arm induration. Magnetic resonance imaging (MRI) revealed that bicep muscle tumor showed high-signal intensity on T1-weighted images and low-signal intensity on T2-weighted images, with heterogenous texture. Needle aspirate of the mass revealed metastasis of squamous cell carcinoma in the bicep muscle. Three months later, the patient died of progressive metastatic disease.

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A Case of Giant Calcifying Epithelioma (Pilomatrixoma) in the Subauricular Region

Kazuhisa Yuki, Ryo Asato, Masato Inoue, Ichiro Tateya, Kennichi Kaneko ...

2004 Volume 97 Issue 8 Pages 731-734
Published: August 01, 2004
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.97.731

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Calcifying epithelioma (pilomatrixoma) is a relatively uncommon benign tumor. It usually presents as a slow-growing subcutaneous or intradermal nodule measuring less than 3cm. In this report, we present a 20-year-old male with giant pilomatrixoma in the subauricular region. We performed en bloc resection of the tumor, which measured 12×9cm. Histopathologically, this tumor did not show any malignant findings. There has not been any evidence of recurrence since the treatment.

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Neck Actinomycosis Developed into Septic Shock

Seigo Ueda, Satoshi Nonaka, Naoki Kanai, Testuji Wada, Hideyuki Ishii, ...

2004 Volume 97 Issue 8 Pages 735-739
Published: August 01, 2004
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.97.735

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Actinomycosis is an inflammatory disease caused primarily by infection by Actinomyces israelii, which is a Gram-positive and anaerobic bacterium, and is often reported to be a chronic purulent disease. It is often necessary to differentiate actinomycosis from tumor. Because of effective usage of antibiotics, the clinical courses of the disease have been getting milder.
A 51-year-old-male was conveyed to our clinic with complaints of clouding of consciousness and neck swelling. His blood pressure was 60/30mmHg and heart rate was from 160 to 170per minute. His neck showed diffuse swelling with flushing. Cervical CT examination revealed the existence of abscess and free air in the right lateral neck. After treatment of septic shock, the abscess was surgically drained under general anesthesia.

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The Situation of Airborne Pollens and Weather Conditions in Kawachinagano City

Yoshimi Kimura, Toshie Arimoto, Kae Fujii, Morihiro Irifune, Yukiko Sa ...

2004 Volume 97 Issue 8 Pages 741-747
Published: August 01, 2004
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.97.741

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Information on pollen dispersion is useful for members of the general public with allergies.
We measured the Japanese cedar and cypress pollen counts by two methods, a Durham sampler and a real-time pollen counter (KH-3000), in Kawachinagano City, located in the south-eastern part of Osaka.
The results were as follows: There were close correlations between the findings of the Durham pollen counter and the KH-3000 in March and April of 2003.
The airborne pollen observed with the KH-3000 did not correlate with the average temperature or average wind velocity of March and April.
There was more airborne pollen dispersion when the wind blew from west-south west and north east.
We concluded that local information about pollen dispersion is important for self-care.

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Unusual Foreign Body in 3 Cases Removed with Difficulty

Aya Itoi, Yuzo Simode, Hideyuki Murata, Makoto Oda, Koichi Tomoda

2004 Volume 97 Issue 8 Pages 749-753
Published: August 01, 2004
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.97.749

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We have experienced unexpected foreign bodies in 3 cases located in the larynx, pharynx and esophagus. The removal procedure and approach for foreign bodies, such as the separation of fish bone by folding in the first case, careful searching of foreign body location in the second case and the abdominal approach for extra large foreign body in the third case must be considered before the treatment. In addition, daily care must be taken for patients with psychologic disorders.

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Superselective Intraarterial Infusion Therapy for Head and Neck Carcinomas

H. Nakatani, [in Japanese]

2004 Volume 97 Issue 8 Pages 754-755
Published: August 01, 2004
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.97.754

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